Once you complete the eligibility and enrollment process with OPWDD, you will need to select and enroll in a Care Coordination Organization (CCO) that serves your community. Most communities are served by more than one CCO. In those cases, you can choose which of the CCOs you’d like to work with.
Enrollment into the CCO is effective the first of the following month after OPWDD Eligibility has been established and Medicaid is active, that’s because to receive Care Management services through a CCO, the only insurance accepted is Medicaid.
Once enrolled, your CCO Care Manager will work with you and your family to develop a detailed Life Plan. This includes identifying the need for Home and Community Based Waiver Services, administered through OPWDD.
What is a Home and Community Based Services (HCBS) Waiver?
A Home and Community Based Services (HCBS) Waiver provides opportunities for Medicaid beneficiaries to receive services in their own home or community. For HCBS Waiver services, the person needs to be OPWDD eligible, have Medicaid, and be enrolled in the HCBS Waiver. HCBS Waiver services include different living, work, and community-based options.
This can all seem confusing, but no worries…The Enrollment Specialist at your CCO will assist you with everything you’ll need for your Medicaid application and the HBCS Waiver.
Please note that Medicaid approval can take a minimum of 3 months.
When can Care Management Services Begin?
Care Management Services begins once OPWDD Eligibility is established and Medicaid is active, Care Management services will begin the first of the following month.
Do I Ever Have to Re-Apply for Services?
- OPWDD Eligibility Services Provisional Eligibility is granted to an individual under the age of 8. If the individual still meets criteria after the age of 8 then permanent eligibility is established.
- If Care Management services are terminated, the person must re-enroll in the CCO/Health Home in order to begin receiving Care Management services again.